Combinations for the treatment of neoplasms using quiescent cell targeting and inhibitors of mitosis

ABSTRACT

The present invention provides compositions and methods for the treatment of neoplasms, in particular, by targeting of quiescent cancer cells with therapeutic agents in combination with other treatments effective against certain neoplastic conditions, in particular, anti-cancer treatment with therapeutic agents that are inhibitors of mitosis (a mitotic inhibitor).

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.15/488,143, filed Apr. 14, 2017, which itself claims the benefit of U.S.Provisional Patent Application No. 62/323,583, filed Apr. 15, 2016, eachof which is incorporated by reference herein in its entirety.

BACKGROUND OF THE INVENTION

Cancer cell quiescence, effectively a cell in a state of sleep, has beenrecognized recently as a major mechanism of the resistance of cancercells to treatments and for providing a pathway for disease recurrence.This quiescence, alternatively called cellular dormancy, is due toarrest at G₀ phase of the cell cycle. Typically, a cell enters a cellcycle from gap phase 1 (G₁), as shown in FIG. 1. After a synthesis phase(S) and a short pre-mitotic interval (G₂), the cell divides by mitosis(M) followed by a return to G₁. Instead of G₁ however, a cell can entercellular dormancy or quiescence, designated as the G₀ phase. Cancercells can either enter an irreversible state before undergoing terminaldifferentiation, termed senescence, or enter a reversible, truequiescent G₀ state from which they could resume cycling, like quiescentfibroblasts (Coller H A, Sang L, and Roberts J M (2006) A newdescription of cellular quiescence, PLoS Biology 4, e83).

A population of cells naturally may be in a quiescent state at any giventime and remain quiescent for an indeterminate period until receipt of asignal to enter the cell division cycle. In one example, the proportionof cancer cells in quiescent state within a population in a tumor may beincreased by environmental factors, such as lack of nutrients, hypoxia,high concentration of reactive oxygen species, etc. Cells may also beinduced into the quiescent state by the action of a drug substance, asin pharmacological quiescence.

The energy and nutrient requirements of a quiescent cell are reducedrelative to a dividing cell. Since current cancer therapies targetdividing cells, as illustrated in FIG. 2, and therefore a cancer cellmust be in the cell division cycle for such treatments to affect it.Accordingly, a quiescent cancer cell is resistant to treatments thataffect one of more cellular proliferation processes by means of damagingexposed DNA, interfering with DNA replication or repair, interferingwith mitosis, or other mechanisms.

Both anticancer therapeutics and radiation treatments produce adverseeffects. Consequently, doses and duration of treatment are limited bytoxicity and lower effective doses and/or shorter treatment durationsare highly desirable. Upon reduction in doses or discontinuation oftreatment, however, the surviving quiescent cancer cells can causecancer recurrence upon re-entry to the cell cycle, the timing of whichcannot be predicted. Further, metastatic cancer cells in the bloodstreammay experience a period of quiescence while they adapt to their newmicroenvironment (Chaffer C L and Weinberg R A (2011) A perspective oncancer cell metastasis, Science 331, 1559-1564). Quiescent cancer cellsdegrade their polyribosomes, thus blocking translation and reducingtotal RNA and protein content. These shrunk cancer cells may be able toenter the bores of capillaries (approximately 8 μm diameter) whereascycling cancer cells are usually much larger (20-30 μm).

Accordingly, the existence of a population of quiescent cancer cellswithin a neoplasm is recognized as an obstacle to successful and durabletreatment (Jackson R C (1989) The problem of the quiescent cancer cell,Advances in Enzyme Regulation 29, 27-46). Evidence for resistance ofquiescent cancer cells derived from various cancer types and to variousanti-cancer treatments has been reported.

Yet, despite a growing appreciation of the importance of cancer cellquiescence, this issue remains unaddressed clinically. Accordingly, thepresent invention provides methods and combinations for the treatment ofneoplasms that features the targeting of quiescent cancers cells bysmall molecules, particularly molecules effective against quiescentcancer cells, in combination with treatments known to be effectiveagainst certain neoplastic cells.

SUMMARY OF THE INVENTION

The present invention provides compositions and methods for thetreatment of neoplasms, in particular, by targeting of quiescent cancercells with therapeutic agents in combination with other treatmentseffective against certain neoplastic conditions, in particular,anti-cancer treatment with therapeutic agents that are inhibitors ofmitosis (a mitotic inhibitor).

Generally, the invention features a method of treating a neoplasmcomprising: administering to a subject in need thereof a therapeuticallyeffective amount of (a) a therapeutic agent effective against quiescentcancer cells; and (b) second agent which is an inhibitor of mitosis,wherein the two agents can be administered sequentially orconcomitantly. In some embodiments, the neoplasm is a cancer or apopulation of cancer cells in vitro or in vivo. In some embodiments, thesubject receiving the treatment is diagnosed with cancer (e.g.,metastatic or pre-metastatic). In some embodiments, the subject has beenpreviously treated with a first-line therapy against cancer. In someembodiments, the subject is treated, or has been treated, with two ormore inhibitors of mitosis sequentially or concomitantly.

In some embodiments, the combined treatment may result in improvedoutcomes, such as increased survival, reduction of severity, delay orelimination of recurrence, or reduced side effects of the primarytreatments (i.e., the inhibitor of mitosis). In some embodiments, thesecond agent is administered at lower dose and/or for a shorter durationwhen administered as part of the combination as compared to a treatmentwith the agent alone. For example, in some embodiments, the EC₅₀ valueof the inhibitor of mitosis is at least 20% lower in the combinationtreatment when compared to the same treatment with the inhibitor ofmitosis alone, as determined, for example, in cell-based assays. In someembodiments, the combination treatment increases fraction of apoptoticcells in a treated population as compared to either agent alone, by atleast by 2-fold as determined, for example, by fraction of sub-G₀ cellsby FACS assay.

In one embodiment, the therapeutic agent effective against quiescentcancer cells is a DYRK1 inhibitor. In some embodiments, the DYRK1inhibitor is a compound that inhibits activity of a DYRK1 kinase, eitherDYRK1A or DYRK1B (in vitro or in vivo), for example, with an IC₅₀ of 100nM or lower in biochemical assays. In some embodiments, the DYRK1inhibitor reduces the fraction of quiescent cancer cells (in vitro or invivo) that would otherwise be found in the absence of such inhibitor,for example, by at least 10%. In some embodiments, the DYRK1 inhibitorinhibits both DYRK1A and DYRK1B. In some embodiments, the DYRK1inhibitor is selective for DYRK1A or DYRK1B.

In one embodiment, the therapeutic agent effective against quiescentcancer cells is a DYRK1 inhibitor. In one embodiment, the DYRK1inhibitor is a compound of formula I:

or a pharmaceutically acceptable salt or solvate thereof, wherein,R₁ is a substituted or unsubstituted C₁₋₈ alkyl, a substituted orunsubstituted phenyl, or a substituted or unsubstituted benzyl;R₂ is phenyl, optionally substituted with up to four groupsindependently selected from halo, CN, NO₂, NHC(O)C₁₋₄ alkyl, C₁₋₄ alkyl,OH, OC₁₋₄ alkyl, wherein two adjacent groups and their interveningcarbon atoms may form a 5- to 6-membered ring containing one or moreheteroatoms selected from N, O, or S.

In one embodiment, the compound of formula I is selected from:

In another embodiment, the methods of the invention further provide (c)administering to the subject another cancer therapy, for example,radiation therapy or other cancer treatment.

In one embodiment, the methods of the invention comprise: administeringto a subject in need thereof a therapeutically effective amount of (a) atherapeutic agent of formula I; (b) an inhibitor of mitosis; and (c)radiation therapy; each therapy being administered sequentially orconcomitantly. For example, in some embodiments, the subject is firsttreated with radiation therapy, whereupon the subject is administered atherapeutic agent of Formula I, alone or in combination with theinhibitor of mitosis. In some embodiments, the subject isco-administered (a) the therapeutic agent effective against quiescentcancer cells, (b) the inhibitor of mitosis and, optionally, (c) theradiation therapy. In some embodiments, the inhibitor of mitosis is aninhibitor of mitosis effective to treat or prevent a neoplasm, includingbut not limited to, all such compounds approved for the treatment ofcancer and compounds that otherwise demonstrate efficacy in treatingcancer in mammalian subject (e.g., mice, rats, dogs, monkeys, humans),and compounds that demonstrate efficacy against neoplastic cells invitro. Many such compounds are known.

In one embodiment, the inhibitor of mitosis is a taxane. In a furtherembodiment, the taxane inhibitor of mitosis is, for example, BMS-188796,BMS-188797, cabazitaxel, DEP cabazitaxel, docetaxel, larotaxel (XP9881,RPR109881), paclitaxel, taxoprexin (DHA-paclitaxel), and tesetaxel(DJ-927).

In another embodiment, the inhibitor of mitosis is a vinca alkaloid. Ina further embodiment, the vinca alkaloid inhibitor of mitosis is, forexample, vinblastine, vincristine, vindesine, vinflunine, andvinorelbine. In another embodiment, the vinca alkaloid inhibitor ofmitosis is vintafolide.

In another embodiment, the inhibitor of mitosis is a PLK1 inhibitor. Ina further embodiment, the PLK1 inhibitor of mitosis is, for example,BI-2536, GSK 461364, GW843682X, HMN-214 and HMN-176, MLN-0905, NMS-P937,rigosertib, Ro3280, SBE 13, and volasertib. In a further embodiment, theinhibitor of mitosis is BI-2536 or GSK461364.

In another embodiment, the neoplasm being treated is a cancer, forexample, biliary cancer, brain cancer, breast cancer, cervical cancer,colon cancer, gastric cancer, kidney cancer, head and neck cancer,leukemia, liver cancer, lung cancer, lymphoma, ovarian cancer,pancreatic cancer, prostate cancer, rectal cancer, sarcoma, skin cancer(e.g. melanoma), testicular cancer, thyroid cancer, or uterine cancer.In a further embodiment, the neoplasm being treated is a bladder cancer,breast cancer, colorectal cancer, non-small cell lung cancer, small celllung cancer, ovarian cancer, and prostate cancer. In furtherembodiments, the cancer is primary or metastatic. In yet furtherembodiments, the cancer is of the type represented by the cell linetypes shown in the Examples.

The embodiments are not meant to be limiting with regard to additionalcombination components, especially therapeutic agents and inhibitorsthat are part of existing treatment combinations, such as, for example,TPF wherein T stands for Taxotere®, that is docetaxel, or PCV wherein Vstands for vincristine sulfate. Similarly, the embodiments are not meantto be limiting with regard to routes and order of administration or withregard to patient type (previously untreated or previously treated,absence or presence of co-morbid conditions, sex, etc.) or stage ofpatient's disease, type of inhibitor of mitosis, etc.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a schematic diagram of a mitotic cycle of a eukaryoticcell.

FIG. 2 shows a schematic diagram of a mitotic cycle of a eukaryoticcancer cell annotated to indicate the stages of the cell cycle uponwhich some of the available anti-cancer therapeutic agents are believedact.

FIG. 3 shows effect of combination of paclitaxel and Compound I-5 (0, 2,and 4 μM) on the growth of SW620 cells.

FIG. 4 shows effect of combination of paclitaxel and Compound I-7 (0, 2,and 4 μM) on the growth of DMS273 cells.

FIG. 5 shows effect of combination of paclitaxel and Compound I-5 (0, 2,and 4 μM) on the growth of LNCap cells.

FIG. 6 shows effect of combination of paclitaxel and Compound I-7 (0, 3,and 6 μM) on the growth of HCC827 cells.

FIG. 7 shows effect of combination of paclitaxel and Compound I-7 (0, 3,and 6 μM) on the growth of A549 cells.

FIG. 8 shows effect of combination of paclitaxel and Compound I-7 (0, 2,4, 8, and 10 μM) on the growth of SK-OV-3 cells.

FIG. 9 shows effect of combination of paclitaxel and Compound I-7 (0, 2,and 4 μM) on the growth of OVCAR3 cells.

FIG. 10 shows effect of combination of docetaxel and Compound I-5 (0, 2,and 4 μM) on the growth of SW620 cells.

FIG. 11 shows effect of combination of docetaxel and Compound I-7 (0, 2,and 4 μM) on the growth of DMS273 cells.

FIG. 12 shows effect of combination of docetaxel and Compound I-7 (0, 3,and 6 μM) on the growth of HCC827 cells.

FIG. 13 shows effect of combination of docetaxel and Compound I-7 (0, 3,and 6 μM) on the growth of A549 cells.

FIG. 14 shows effect of combination of docetaxel and Compound I-7 (0, 4,and 8 μM) on the growth of SK-OV-3 cells.

FIG. 15 shows effect of combination of docetaxel and Compound I-7 (0, 2,and 4 μM) on the growth of OVCAR3 cells.

FIG. 16 effect of combination of vincristine and Compound I-5 (0, 2, and4 μM) on the growth of DMS273 cells.

FIG. 17 shows effect of combination of vincristine and Compound I-5 (0,2, and 4 μM) on the growth of H1975 cells.

FIG. 18 shows effect of combination of vincristine and Compound I-7 (0,4, and 8 μM) on the growth of SK-OV-3 cells.

FIG. 19 shows effect of combination of vincristine and Compound I-7 (0,1, and 3 μM) on the growth of OVCAR3 cells.

FIG. 20 shows effect of combination of vinorelbine and Compound I-5 (0,2, and 4 μM) on the growth of DMS273 cells.

FIG. 21 shows effect of combination of vinorelbine and Compound I-5 (0,2, and 4 μM) on the growth of H1975 cells.

FIG. 22 shows effect of combination of vinorelbine and Compound I-7 (0,1, and 3 μM) on the growth of OVCAR3 cells.

FIG. 23 shows effect of combination of vincristine and Compound I-7 (0,4, and 8 μM) on the growth of SK-OV-3 cells.

FIG. 24 shows effect of combination of vincristine and Compound I-7 (0,3, and 6 μM) on the growth of A549 cells.

FIG. 25 shows effect of combination of B12536 and Compound I-7 (0, 2,and 4 μM) on the growth of H1975 cells.

FIG. 26 shows effect of combination of B12536 and Compound I-7 (0, 2,and 4 μM) on the growth of PANC1 cells.

FIG. 27 shows effect of combination of B12536 and Compound I-7 (0, 2,and 4 μM) on the growth of DMS273 cells.

FIG. 28 shows effect of combination of B12536 and Compound I-7 (0, 2,and 4 μM) on the growth of A549 cells.

FIG. 29 shows effect of combination of GSK461364 and Compound I-7 (0, 2,and 4 μM) on the growth of H1975 cells.

FIG. 30 shows effect of combination of GSK461364 and Compound I-7 (0, 2,and 4 μM) on the growth of PANC1 cells.

FIG. 31 shows effect of combination of GSK461364 and Compound I-7 (0, 2,and 4 μM) on the growth of DMS273 cells.

FIG. 32 shows effect of combination of GSK461364 and Compound I-7 (0, 3,and 6 μM) on the growth of A549 cells.

FIG. 33 shows FACS analyses of cell cycle distribution of DMS273 cellsincubated for 24 hours in Panel A: FBS+ media; Panel B: FBS− media;Panel C: FBS+ media with 4 μM Compound I-7; Panel D: FBS+ media with 2.7nM paclitaxel; Panel E: FBS+ media with 5 μM Compound I-7 and 2 nMpaclitaxel.

FIG. 34 shows FACS analyses of cell cycle distribution of SW620 cellsincubated for 24 hours in Panel A: FBS+ media; Panel B: FBS− media;Panel C: FBS+ media with 4 μM Compound I-7; Panel D: FBS+ media with 2nM paclitaxel; Panel E: FBS+ media with 4 μM Compound I-7 and 2 nMpaclitaxel.

FIG. 35 shows FACS analyses of cell cycle distribution of DMS273 cellsincubated for 24 hours in Panel A: FBS+ media; Panel B: FBS− media;Panel C: FBS+ media with 4 μM Compound I-7; Panel D: FBS+ media with 1.1nM vincristine; Panel E: FBS+ media with 4 μM Compound I-7 and 1.1 nMvincristine.

FIG. 36 shows FACS analyses of cell cycle distribution of DMS273 cellsincubated for 24 hours in Panel A: FBS+ media; Panel B: FBS− media;Panel C: FBS+ media with 4 μM Compound I-7; Panel D: FBS+ media with 8.1nM vinorelbine; Panel E: FBS+ media with 4 μM Compound I-7 and 8.1 nMvinorelbine.

FIG. 37 FACS analyses by DNA content of cell cycle distribution of SW620cells. The cells were incubated in Panel A: 24 hours in FBS− media;Panel B: 24 hours in FBS− media with 2.5 μM AZ191; Panel C: 24 hours inFBS− media with 5 μM AZ191; Panel D: 24 hours in FBS− media with 10 μMAZ191.

FIG. 38 shows FACS analyses by DNA content of cell cycle distribution ofSW620 cells. The cells were incubated in Panel A: 24 hours in FBS− mediawith DMSO control; Panel B: 24 hours in FBS− media with 1.25 μM CompoundI-7; Panel C: 24 hours in FBS− media 2.5 μM Compound I-7; Panel D: 24hours in FBS− media with 5 μM Compound I-7.

DETAILED DESCRIPTION OF THE INVENTION Glossary

In the present invention, an “alkyl” group is a saturated, straight orbranched, hydrocarbon group, comprising from 1 to 8 carbon atoms (C₁₋₈alkyl group), in particular from 1 to 6, or from 1 to 4 carbons atoms,unless otherwise indicated. Examples of alkyl groups having from 1 to 6carbon atoms inclusive are methyl, ethyl, propyl (e.g., n-propyl,iso-propyl), butyl (e.g., tert-butyl, sec-butyl, n-butyl), pentyl (e.g.,neo-pentyl), hexyl (e.g., n-hexyl), 2-methylbutyl, 2-methylpentyl andthe other isomeric forms thereof. Alkyl groups may be unsubstituted orsubstituted by at least one group chosen from halogen atoms, cycloalkyl,heterocycloalkyl, aryl, heteroaryl, hydroxyl, alkoxyl, alkenyl, alkynyl,CN, nitro, and amino groups.

In the present invention, an “alkenyl” group is a straight or branchedhydrocarbon group comprising at least one double carbon-carbon bond,comprising from 2 to 8 carbon atoms (unless otherwise indicated).Examples of alkenyl groups containing from 2 to 6 carbon atoms arevinyl, allyl, 1-propenyl, 2-propenyl, 1-butenyl, 2-butenyl, 3-butenyl,1-pentenyl, 2-pentenyl, 3-pentenyl, 4-pentenyl, 1-hexenyl, 2-hexenyl,3-hexenyl, 4-hexenyl, 5-hexenyl and the isomeric forms thereof. Alkenylgroups may be unsubstituted, or substituted by at least one group chosenfrom halogen atoms, cycloalkyl, heterocycloalkyl, aryl, heteroaryl,hydroxyl, alkoxyl, alkenyl, alkynyl, CN, nitro, and amino groups.

In the present invention, an “alkynyl” group is a straight or branchedhydrocarbon group comprising at least one triple carbon-carbon bond,comprising from 2 to 8 carbon atoms. Alkynyl groups may be substitutedby at least one group chosen from halogen atoms, cycloalkyl,heterocycloalkyl, aryl, heteroaryl, hydroxyl, alkoxyl, alkenyl, alkynyl,CN, nitro, and amino groups.

In the present invention, an “aryl” group is an aromatic hydrocarboncycle, comprising from 5 to 14 carbon atoms. Most preferred aryl groupsare mono- or bi-cyclic and comprises from 6 to 14 carbon atoms, such asphenyl, alpha-naphtyl, 3-naphtyl, antracenyl, preferably phenyl. “Aryl”groups also include bicycles or tricycles comprising an aryl cycle fusedto at least another aryl, heteroaryl, cycloalkyl or heterocycloalkylgroup, such as benzodioxolane, benzodioxane, dihydrobenzofurane orbenzimidazole. Aryl groups may be unsubstituted, or substituted by atleast one (e.g. 1, 2 or 3) group chosen from halogen atoms, cycloalkyl,heterocycloalkyl, aryl, heteroaryl, hydroxyl, alkoxyl, alkenyl, alkynyl,CN, nitro, and amino groups. In addition, aryl groups may be substitutedby adjacent substituents which can, taken together with the carbon atomto which they are attached, form a 5- to 6-membered ring which maycontain one or more heteroatom(s) selected from N, O, and S.

In the present invention, a “halogen atom” or “halo” is a Cl, Br, F, orI atom.

In the present invention, an “alkoxyl” group is an alkyl group linked tothe rest of the molecule through an oxygen atom, of the formula O-alkyl.

In the present invention, an “amino” group is a NH₂, NH-alkyl, orN(alkyl)₂ group.

In the present invention, a “heteroaryl” group is an aryl group whosecycle is interrupted by at least at least one heteroatom, for example aN, O, or S, atom, such as thiophene or pyridine. Heteroaryl groups maybe unsubstituted, or substituted by at least one (e.g. 1, 2 or 3) groupchosen from halogen atoms, cycloalkyl, heterocycloalkyl, aryl,heteroaryl, hydroxyl, alkoxyl, alkenyl, alkynyl, CN, nitro and aminogroups. In addition, heteroaryl groups may be substituted by adjacentsubstituents which can, taken together with the carbon atom to whichthey are attached, form a 5- to 6-membered ring which may contain one ormore heteroatom(s) selected from N, O, and S.

In the present invention, a “cycloalkyl” denotes a saturated alkyl groupthat forms one cycle having preferably from 3 to 14 carbon atoms, andmore preferably 3 to 8 carbon atoms, such as cyclopropyl, cyclobutyl,cyclopentyl, cyclohexyl, cycloheptyl, and cyclooctyl. Cycloalkyl groupsmay be unsubstituted or substituted by at least one (e.g. 1, 2 or 3)group chosen from halogen atoms, cycloalkyl, heterocycloalkyl, aryl,heteroaryl, hydroxyl, alkoxyl, alkenyl, alkynyl, CN, nitro, and aminogroups. In addition, cycloalkyl groups may be substituted by adjacentsubstituents which can, taken together with the carbon atom to whichthey are attached, form a 5- to 6-membered ring which may contain one ormore heteroatom(s) selected from N, O, and S.

In the present invention, a “heterocycloalkyl” group is a cycloalkylgroup comprising at least one heteroatom, such as pyrrolidine,tetrahydrothiophene, tetrahydrofuran, piperidine, pyran, dioxin,morpholine or piperazine. A heterocycloalkyl group may in particularcomprise from four to fourteen carbon atoms, such as morpholinyl,piperidinyl, pyrrolidinyl, tetrahydropyranyl, dithiolanyl.Heterocycloalkyl groups may be unsubstituted, or substituted by at leastone group chosen from halogen atoms, cycloalkyl, heterocycloalkyl, aryl,heteroaryl, hydroxyl, alkoxyl, alkenyl, alkynyl, CN, nitro and aminogroups. In addition, heterocycloalkyl groups may be substituted byadjacent substituents which can, taken together with the carbon atom towhich they are attached, form a 5- to 6-membered ring which may containone or more heteroatom(s) selected from N, O, and S.

As used herein, a “neoplasm” means an abnormal mass of tissue thatresults from neoplasia. “Neoplasia” means a process of an abnormalproliferation of cells. In some embodiments of the invention, a neoplasmis a solid cancer, or alternately a hematopoietic cancer. The neoplasiamay be benign, pre-malignant, or malignant. The term neoplasmencompasses mammalian cancers, in some embodiments, human cancers, andcarcinomas, sarcomas, blastomas of any tissue (for exampleadenocarcinomas, squamous cell carcinoma, osteosarcomas, etc.), germcell tumors, glial cell tumors, lymphomas, leukemias, including solidand lymphoid cancers, kidney, breast, lung, bladder, colon, ovarian,prostate, rectal, pancreatic, stomach, brain, head and neck, skin,uterine, cervical, testicular, esophagus, thyroid, biliary cancer, livercancer, and cancer of the bone and cartilaginous tissue, includingnon-Hodgkin's lymphomas (e.g., Burkitt's, Small Cell, and Large Celllymphomas) and Hodgkin's lymphoma, leukemia, multiple myeloma, andmyelodysplastic syndrome.

As used herein, the terms “treat,” “treating,” or “treatment,” mean tocounteract a medical condition (e.g., cancer) to the extent that themedical condition is improved according to a clinically-acceptablestandard. Improvement in cancer can include: 1) reduced rate of tumorgrowth (tumor growth inhibition), 2) tumor shrinkage (regression), 3)remission, whether partial or total, 4) reduction in metastases, 5)prolonging progression free survival, and 6) delay or elimination ofrecurrence. In certain embodiments of the invention, treating includesachieving, partially or substantially, one or more of the followingresults: partially or totally reducing the cancer mass, or volume, orthe malignant cell count; ameliorating or improving a clinical symptomor indicator associated with solid cancers or hematopoietic cancers;delaying, inhibiting, or preventing the progression of solid cancers orhematopoietic cancers; or partially or totally delaying, inhibiting orpreventing the onset or development of solid cancers or hematopoieticcancers. “Treatment” also can mean prolonging survival compared toexpected survival without treatment or compared to standard of caretreatment.

Treating includes prophylactic or preventative treatment. “Prophylactictreatment” refers to treatment before appearance or re-appearance ofclinical symptoms of a target disorder to prevent, inhibit, or reduceits occurrence, severity, or progression.

As used herein, an “effective amount” refers to an amount of atherapeutic agent or a combination of therapeutic agents that istherapeutically or prophylactically sufficient to affect the desiredimprovement in the targeted disorder. Examples of effective amountstypically range from about 0.0001 mg/kg of body weight to about 500mg/kg of body weight per single administered dose, such doses beingadministered once or over a period of time. An example range is fromabout 0.0001 mg/kg of body weight to about 5 mg/kg per dose. In otherexamples, the range can be from about 0.0001 mg/kg to about 5 mg/kg persingle administered dose. In still other examples, effective amountsrange from about 0.01 mg/kg of body weight to 50 mg/kg of body weightper single administered dose, or from 0.01 mg/kg of body weight to 0.1mg/kg, 0.5 mg/kg, 1 mg/kg, 2 mg/kg, 3 mg/kg, 4 mg/kg, 5 mg/kg, 6 mg/kg,10 mg/kg, 20 mg/kg, 25 mg/kg, 30 mg/kg, or 40 mg/kg of body weight persingle administered dose. For agents of known clinical use, an exampleof an effective dose is that amount approved of by a regulatory agencyfor treatment of an indication.

As used herein, the term “subject” refers to a mammal, for example ahuman, but can also mean an animal in need of veterinary treatment,e.g., companion animals (e.g., dogs, cats, and the like), farm animals(e.g., cows, sheep, pigs, horses, and the like), and laboratory animals(e.g., rats, mice, guinea pigs, and the like).

As used herein, the term “therapeutic agent” means any chemical moleculeused or contemplated for use or investigated for use in cancertreatment, including cytotoxic, cytostatic, or targeted agents, whethersmall molecules, or peptides, or antibodies, or oligonucleotides,irrespective of mechanism of action. As used herein, the terms“therapeutic” or “therapeutic agent” refer to either the activepharmaceutical ingredient (API) or its pharmaceutically acceptable saltor hydrate (solvate), or a drug product containing the therapeuticagent, however formulated, and whether API is amorphous or crystallineand of whatever polymorphic form. Formulation means a combination of anactive pharmaceutical ingredient (API, drug substance) or ingredients(APIs) combined with excipients and/or delivery vehicle to make anadministrable dosage form (drug product). For example, as used herein, areference to paclitaxel includes Taxol®, Abraxane®, Lipusu®, and anyother drug product with paclitaxel as the active ingredient.

The therapeutic agents of the invention can be administered alone, butare generally administered with a pharmaceutically acceptable carrier,with respect to standard pharmaceutical practice (such as described inRemington's Pharmaceutical Sciences, Mack Publishing). Accordingly, afurther object of this invention relates to pharmaceutical compositionsdefined herein and pharmaceutically acceptable carriers.

As used herein, the term “inhibitor” means any composition that reducesthe activity of an enzyme. An example of an inhibitor is a chemicalmolecule. A measure of the potency of an inhibitor is its “50%inhibitory concentration” (IC₅₀). IC₅₀ concentration or IC₅₀ value isthe concentration of an inhibitor at which 50% of the enzymatic activityis inhibited by the inhibitor. Methods for the determination of IC₅₀values, for example, of kinase inhibitors are known to persons ofordinary skill in the art and include direct and indirect functionalassays, such as the HotSpot™ kinase assay technology (Reaction BiologyCorporation, Malvern, Pa., www.reactionbiology.com) or competitionbinding assays, such as KINOMEscan® (DiscoverX Corporation, Freemont,Calif., www.discoverx.com).

A measure of the potency of a therapeutic agent against a cell line isits “50% effective concentration” (EC₅₀). EC₅₀ concentration or EC₅₀value is the concentration of a drug that produces half-maximalresponse, such as, for example, 50% growth inhibition or 50% reductionin cell viability. Methods for the determination of EC₅₀ values, forexample, of kinase inhibitors are known to persons of ordinary skill inthe art.

As used herein, the term “quiescence” or “quiescent state” refers to theG₀ state of the cell cycle, as understood by the practitioners of theart.

As used herein, the term “therapeutic agent effective against quiescentcancer cells” refers to a molecule that either reduces the fraction ofquiescent cancer cells in a cell population or prevents, completely orsubstantially, an increase in fraction of quiescent cancer cells in acell population under conditions that otherwise would lead to such anincrease.

A “quiescent neoplastic cell”, alternately referred to as a “quiescentcancer cell” means a cancer cell that exists in the quiescent, or G₀,state of the cell cycle. A “fraction of quiescent neoplastic cells” or“fraction of quiescent cancer cells”, as used herein, means the portionof a cancer cell population that exists in the G₀ state of the cellcycle. Determining the fraction of quiescent neoplastic cells includescharacterizing a cell population by distribution of its constituentcells within the stages of the cell cycle. The fraction of cells in theG₀ state (i.e., quiescent neoplastic cells) is quantified relative tothe total cell population. The fraction may be expressed as a percentageof the total cell population (i.e. (number of quiescent cells divided bytotal cells in cell population) multiplied by 100). Characterization ofthe cell population by distribution of its constituent cells within thestages of the cell cycle may be achieved by techniques known to personsof ordinary skill in the art, and may include analysis by DNA and/or RNAcontent using flow cytometry methods, for example,fluorescence-activated cell sorting (FACS).

DETAILED DESCRIPTION

The present invention provides compositions and methods for thetreatment of neoplasms, in particular, by targeting of quiescent cancerscells with therapeutic agents in combination with other treatmentseffective against certain neoplastic conditions, in particular,anti-cancer treatment with therapeutic agents which are inhibitors ofmitosis.

Generally, the invention features a method of treating a neoplasmcomprising: administering to a subject in need thereof a therapeuticallyeffective amount of (a) a therapeutic agent effective against quiescentcancer cells; and (b) second agent which is an inhibitor of mitosis,wherein the two agents can be administered sequentially orconcomitantly. In some embodiments, the neoplasm is a cancer or apopulation of cancer cells in vitro or in vivo. In some embodiments, thesubject receiving the treatment is diagnosed with cancer (e.g.,metastatic or pre-metastatic). In some embodiments, the subject has beentreated previously with a first-line therapy against cancer. In someembodiments, the subject has been treated previously with second-lineand/or other therapies. In some embodiments, the subject is treated, orhas been treated, with radiation therapy. In some embodiments, thesubject was treated with surgery, for example to resect or de-bulk atumor. In other embodiments, the subject's neoplasm has recurred. Insome embodiments, the subject is treated, or has been treated, with twoor more inhibitor of mitosis sequentially or concomitantly.

In some embodiments, the combined treatment may result in improvedoutcomes, such as increased survival, reduction of severity, delay orelimination of recurrence, or reduced side effects of the primarytreatments (i.e., the inhibitor of mitosis). In some embodiments, thesecond agent is administered at lower dose and/or for a shorter durationwhen administered as part of the combination as compared to a treatmentwith the agent alone. For example, in some embodiments, the EC₅₀ valueof the inhibitor of mitosis is at least 20%, 25%, 30%, 40%, 50%, 100%,3-fold, 5-fold, 10-fold lower in the combination treatment when comparedto the same treatment with the first agent, as determined, for example,in cell-based assays. In some embodiments, the combination treatmentincreases fraction of apoptotic cells in a treated population ascompared to either agent alone, by at least by 2-fold, 3-fold, 4-fold,5-fold as determined, for example, by fraction of sub-G₀ phase cells ina FACS assay.

In one embodiment, the therapeutic agent effective against quiescentcancer cells is a DYRK1 inhibitor. In some embodiments, the DYRK1inhibitor is a compound that inhibits activity of a DYRK1 kinase, eitherDYRK1A or DYRK1B (in vitro or in vivo), for example, with an IC₅₀ valueof <100 nM, <90 nM, <80 nM, <70 nM, <60 nM, <50 nM, <40 nM, <30 nM, <20nM, <10 nM, <5 nM or lower in biochemical assays. In some embodiments,the DYRK1 inhibitor reduces the fraction of quiescent cancer cells (invitro or in vivo) in a population or a tumor that would otherwise befound in the absence of such inhibitor, for example, by at least 5%,10%, 15%, 20%, 25%, 30%, 40%, 50% or more.

In some embodiments, the DYRK1 inhibitor inhibits both DYRK1A andDYRK1B. In some embodiments, the DYRK1 inhibitor is selective forDYRK1A, with ratio of DYRK1B IC₅₀ to DYRK1A IC₅₀ of 1000, 100, 50, 25,10 to 1. In some embodiments, the DYRK1 inhibitor is selective forDYRK1B, with ratio of DYRK1A IC₅₀ to DYRK1B IC₅₀ of 1000, 100, 50, 25,10, or 5 to 1. In some embodiments, the DYRK1 inhibitor is selective forDYRK1 by at least 4-fold, 5-fold, 10-fold, 20-fold, 50-fold, 100-fold ascompared to DYRK2 and/or DYRK3 and/or DYRK4, as determined by ratios ofIC₅₀ values. In some embodiments, the DYRK1 inhibitor is selective forDYRK1 by at least 4-fold, 5-fold, 10-fold, 20-fold, 50-fold, 100-fold,500-fold, 1000-fold as compared to cyclin dependent kinases (CDKs) such,as for example, CDK2, as determined by ratios of IC₅₀ values.

Examples of known DYRK1 inhibitors include AZ191, DYRKi, harmine, ID-8,leucettine L41, NCGC00185981, INDY, ProINDY, TC-S 7004, and TG003. Atleast one known DYRK1 inhibitor, TC-S 7004, (US20120184562) is reportedto be effective against quiescent cancer cells in vitro (Ewton D Z, HuJ, Vilenchik M, Deng X, Luk K C, Polonskaia A, Hoffman A F, Zipf K,Boylan J F, and Friedman E A. (2011) Inactivation of MIRK/DYRK1B kinasetargets quiescent pancreatic cancer cells. Molecular Cancer Therapeutics10: 2104-2114).

In one embodiment, the DYRK1 inhibitor is a compound of formula I:

or a pharmaceutically acceptable salt or solvate thereof, wherein,R₁ is a substituted or unsubstituted C₁₋₈ alkyl, a substituted orunsubstituted phenyl, or a substituted or unsubstituted benzyl;R₂ is phenyl, optionally substituted with up to four groupsindependently selected from halo, CN, NO₂, NHC(O)C₁₋₄ alkyl, C₁₋₄ alkyl,OH, OC₁₋₄ alkyl, wherein two adjacent groups and their interveningcarbon atoms may form a 5- to 6-membered ring containing one or moreheteroatoms selected from N, O, or S.

In one embodiment, the compound of formula I is selected from:

In another embodiment, the methods of the invention further provide (c)administering to the subject another cancer therapy, for example,radiation therapy or other cancer treatment.

In one embodiment, the methods of the invention comprise: administeringto a subject in need thereof a therapeutically effective amount of (a) atherapeutic agent of formula I; (b) an inhibitor of mitosis; and (c)radiation therapy; each therapy being administered sequentially orconcomitantly. For example, in some embodiments, the subject is firsttreated with radiation therapy, whereupon the subject is administered atherapeutic agent of Formula I, alone or in combination with theinhibitor of mitosis. In some embodiments, the subject isco-administered (a) the therapeutic agent effective against quiescentcancer cells, (b) the inhibitor of mitosis, and, optionally (c) theradiation therapy.

In some embodiments, the inhibitor of mitosis is an inhibitor of mitosiseffective to treat or prevent a neoplasm, including but not limited to,all such compounds approved for the treatment of cancer, compounds inclinical trials for the treatment of cancer, compounds that otherwisedemonstrate efficacy in treating cancer in mammalian subject (e.g.,mouse, rats, monkeys, humans), and compounds that demonstrate efficacyagainst neoplastic cells in vitro. Many such compounds are known.

In one embodiment, the inhibitor of mitosis is a taxane. Taxanes usefulfor the methods of the invention include BMS-188796, BMS-188797,cabazitaxel, DEP cabazitaxel, docetaxel, larotaxel (XRP9881, RPR109881),paclitaxel, taxoprexin (DHA-paclitaxel), and tesetaxel (DJ-927).

In another embodiment, the inhibitor of mitosis is a vinca alkaloid.Vinca alkaloids useful for the methods of the invention includevinblastine, vincristine, vindesine, vinflunine, and vinorelbine. Inanother embodiment, the vinca alkaloid inhibitor of mitosis isvintafolide.

In another embodiment, the inhibitor of mitosis is a PLK1 inhibitor.PLK1 inhibitors useful for the methods of the invention include BI-2536,GSK461364, GW843682X, HMN-214 and HMN-176, MLN-0905, NMS-P937,rigosertib, Ro3280, SBE 13, and volasertib. In a further embodiment, theinhibitor of mitosis is BI-2536 or GSK461364.

In another embodiment, a neoplasm is biliary cancer, brain cancer,breast cancer, cervical cancer, colon cancer, gastric cancer, head andneck cancer, kidney cancer, leukemia, liver cancer, non-small cell lungcancer, small cell lung cancer, lymphoma, ovarian cancer, pancreaticcancer, prostate cancer, rectal cancer, sarcoma, skin cancer (e.g.melanoma), testicular cancer, thyroid cancer, or uterine cancer. In afurther embodiment, the neoplasm is selected from bladder cancer, breastcancer, colorectal cancer, non-small cell lung cancer, small cell lungcancer, ovarian cancer, and prostate cancer. In further embodiments, thecancer is primary or metastatic. In yet further embodiments, the canceris of the type represented by the cell line types shown in the Examples.

The embodiments are not meant to be limiting with regard to additionalcombination components, especially compounds that are part of existingtreatment combinations, such as, for example, TPF wherein T stands forTaxotere®, that is docetaxel, or PCV wherein V stands for vincristinesulfate. The embodiments described here are illustrative and are notmeant to be limiting with regard to routes and order of administration,patient type (previously untreated or previously treated, absence orpresence of co-morbid conditions, age, sex, etc.), or stage of patient'sdisease, type of inhibitor of mitosis, etc.

Inhibitors of mitosis are known in the art (Dominguez-Brauer C, et al,(2015) Targeting mitosis in cancer: emerging strategies, Molecular Cell60, 524-536). As used herein, the terms “inhibitor of mitosis” and“mitotic inhibitor” are equivalent and may be used interchangeably. Aninhibitor of mitosis interrupts cell cycling during the M phase or at acheckpoint entering (the G₂/M checkpoint) or leaving (the post-mitoticcheckpoint) the M phase. In M phase, the chromosomes and cytoplasm aredivided into two daughter cells (cytokinesis). Mitosis proceeds in fivephases: prophase, prometaphase, metaphase, anaphase, and telophase andan inhibitor of mitosis can interrupt any of these phases. Examplesinhibitors of mitosis include taxanes, vinca alkaloids, and PLK1inhibitors.

For example, taxanes include BMS-188796, BMS-188797, cabazitaxel, DEPcabazitaxel, docetaxel, larotaxel (XRP9881, RPR109881), paclitaxel,taxoprexin (DHA-paclitaxel), and tesetaxel (DJ-927); vinca alkaloidsinclude vincristine, vinblastine, vindesine, vinflunine, andvinorelbine; PLK1 inhibitors include BI-2536, GSK461364, GW843682X,HMN-214 and HMN-176, MLN-0905, NMS-P937, rigosertib, Ro3280, SBE 13, andvolasertib.

A G₀ state is maintained by a specific program of gene expression. DYRK1kinases, such as DYRK1A and DYRK1B, may be important for the maintenanceof cancer cells in G₀ state (quiescent state).

DYRK1B/Mirk is a member of the Minibrain/DYRK family of kinases whichmediates survival and differentiation in certain normal tissues.(Kentrup H, Becker W, Heukelbach J, Wilmes A, Schurmann A, Huppertz C,Kainulainen H, and Joost H G (1996) Dyrk, a dual specificity proteinkinase with unique structural features whose activity is dependent ontyrosine residues between subdomains VII and VIII, Journal of BiologicalChemistry 271, 3488-3495; Becker W, Weber Y, Wetzel K, Eirmbter K,Tejedor F J, and Joost H G (1998) Sequence characteristics, subcellularlocalization, and substrate specificity of DYRK-related kinases, a novelfamily of dual specificity protein kinases, Journal of BiologicalChemistry 273, 25893-25902). DYRK1B is expressed at detectable levels inskeletal muscle cells and testes. Knockout of DYRK1B caused no evidentabnormal phenotype in mice even in developing muscle, suggesting thatDYRK1B is not an essential gene for normal development. Supporting thisinterpretation, normal fibroblasts exhibited no alteration in survivalafter 20-fold depletion of DYRK1B kinase levels. Thus, DYRK1B does notappear to be an essential gene for survival of normal cells yet there isevidence that it is upregulated in certain malignant cancer cells inwhich DYRK1B is believed to mediate survival by retaining cancer cellsin quiescent state. These unusual characteristics suggest that DYRK1Bmay be an attractive target for therapeutic intervention and inparticular for anti-cancer therapy directly against quiescent cancercells.

The disclosed combinations and methods may afford one or more of theimprovements as defined in the Glossary relative to the use of eachindividual components or existing single and combination treatments.Also, the disclosed combinations and methods may permit reduction indoses and/or frequency of administration of therapeutic agents andradiation to achieve the same improvements as a result of treatmentrelative to what is possible using individual components or existingsingle and combination treatments.

The disclosed combinations need not be synergistic to yield asignificant improvement in the effectiveness of treatment relative tosingle therapy with an inhibitor of mitosis. As discussed above,quiescent cancer cells are inherently less susceptible to anti-cancertherapeutics, including mitotic inhibitors, and even a small fraction ofquiescent cells that survives post treatment can lead to recurrence.Consequently, eradicating the resistant, quiescent cell populations in aneoplasm may or may not yield a synergistic reduction in EC₅₀ values yetmay yield a significant improvement in cancer recurrence and appearanceof metastatic neoplasms.

The administration regimen and routes of administration of the disclosedcombinations may well vary depending on the neoplasm treated, extent ofprogression of the neoplasm, exact combination selected, age, sex, andphysical condition of the subject, and other factors. Administrationregimen may include multiple doses per period of time, the treatmentsadministered concurrently or sequentially, etc. Furthermore, thecombinations may be administered to subjects who are naive to treatment(have not been treated), or subjects who underwent previous treatments,or have undergone surgical resection or debulking of a solid tumor, orsubjects whose cancers relapsed. For example, therapeutic agenteffective against quiescent cancer cells may be administered before theinhibitor of mitosis. The therapeutic agent effective against quiescentcancer cells may be administered 6 hours, 12 hours, 24 hours, 48 hours,72 hours, 96 hours, one week before the inhibitor of mitosis. Thetherapeutic agent effective against quiescent cancer cells may beadministered at the same time (concomitantly) as the inhibitor ofmitosis. The therapeutic agent effective against quiescent cancer cellsmay be administered 6 hours, 12 hours, 24 hours, 48 hours, 72 hours, 96hours after the inhibitor of mitosis. The therapeutic agent effectiveagainst quiescent cancer cells and/or the inhibitor of mitosis may beadministered before, after, or concomitantly with radiation or othertherapy.

The therapeutic agent effective against quiescent cancer cells may beadministered daily, every two days, every three days, every four days,once weekly, once every two weeks, once per month by oral, intravenous(IV), intraperitoneal (IP), subcutaneous (SC), intratumoral (IT),intrathecal, or other routes of administration.

The combinations may be administered to subjects who are naive totreatment (have not been treated), or subjects who underwent previoustreatments with first-line, second-line, third-line, or other therapies,radiation treatments, or have undergone surgical resection or debulkingof a solid tumor, or subjects whose cancers relapsed, or subjects whosecancers are non-metastatic or metastatic.

EXAMPLES

The following examples are not intended to be limiting. Those of skillin the art will, in light of the present disclosure, appreciate thatmany changes can be made in the specific materials and which aredisclosed and still obtain a like or similar result without departingfrom the spirit and scope of the invention.

Example 1. Determination of Fraction of Quiescent Cancer Cells within aPopulation

The following cell lines were obtained from ATCC and cultured accordingto the ATCC recommendations: DMS273—small cell lung cancer cell line;H1975—non-small cell lung cancer cell line harboring L858R and T790Mmutations in EGFR TK; A549—a non-small cell lung cancer cell line withwild type EGFR; LNCap—prostate cancer cell line; SW620—colon cancer cellline; MiaPaCa2—pancreatic cancer cell line; PANC1—pancreatic cancer cellline; OVCAR3—ovarian cancer cell line; SK-OV-3—ovarian cancer cell line.

Cell cultures were seeded into 6-well plates at 3×10⁵-6×10⁵ cells/well;the plated number of cells depended on cell size and rate ofproliferation, aiming for approximately 50% confluency. After seeding,the cells were allowed to attach for 24 hours while incubated at 37° C.in a humidified 5% CO₂ atmosphere, and then treated with compounds fordesired amount of time (usually 24 hours) incubating under sameconditions. Then the cells were harvested by trypsinization, pooled withthe floating cells, washed in PBS, and fixed in 70% ice-cold ethanolovernight. For Acridine Orange (AO) staining, fixed cells were washedonce with ice-cold PBS, re-suspended in 100 μL PBS, followed by additionof 200 μL of permeabilizing solution and 600 μL AO staining solution.The measurements were performed with Guava easyCyte HT flow cytometer(EMD Millipore) using the blue laser for excitation at 488 nm,monitoring emission of the AO-DNA complex at 526 nm and AO-RNA complexat 650 nm. The complete protocol and composition of buffers aredescribed in the literature (Darzynkiewicz Z, Juan G, and Srour E F(2004) Differential Staining of DNA and RNA (2004). Current Protocols inCytometry, Chapter 7:Unit 7.3).

Example 2. General Procedure for the Cell Viability Assays

For viability analysis, cells were seeded into 96-well plates at2×10³-6×10³ cells/well; the plated number of cells depended on cell sizeand rate of proliferation aiming for approximately 50% confluency. Afterseeding, the cells were allowed to attach for 24 hours incubated at 37°C. in a humidified 5% CO₂ atmosphere.

The treatments were performed using at least 6 different concentrationsof a compound in 1:3 serial dilutions in DMSO such that the DMSOconcentration in the cell medium was <1%. The cell cultures wereincubated for an additional 96 hours in 5% CO₂ incubator at 37° C.Treatments were performed in triplicate. Results were analyzed byCellTiter-Glo™ Luminescent Cell Viability Assay (Promega, cat. # G7571)according to the manufacturer's instructions using Spectra MAX GeminiSpectrophotometer (Molecular Devices).

Example 3. Combination of a Molecule Effective Against Quiescent CancerCells with Paclitaxel

SW620 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of paclitaxel used in thisassay was 100 nM and the concentrations of Compound I-5 were 2 μM and 4accordingly. The observed EC₅₀ values of paclitaxel were 8.1 nM whenCompound I-5 was not present, 2.3 nM when Compound I-5 was present at aconcentration of 2 and 0.2 nM when Compound I-5 was present at aconcentration of 4 μM. See FIG. 3.

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of paclitaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of paclitaxel were 2.7 nM when Compound I-7was not present, 1.9 nM when Compound I-7 was present at a concentrationof 2 μM, and 0.9 nM when Compound I-7 was present at a concentration of4 μM. See FIG. 4.

LNCap cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of paclitaxel used in thisassay was 10 nM and the concentrations of Compound I-5 were 2 μM and 4μM. The observed EC₅₀ values of paclitaxel were 3.2 nM when Compound I-5was not present, 2.1 nM when Compound I-5 was present at a concentrationof 2 μM, and 0.9 nM when Compound I-5 was present at a concentration of4 μM. See FIG. 5.

HCC827 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of paclitaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 3 μM and 6μM. The observed EC₅₀ values of paclitaxel were 4.2 nM when Compound I-7was not present, 2.5 nM when Compound I-7 was present at a concentrationof 3 μM, and 0.6 nM when Compound I-7 was present at a concentration of6 μM. See FIG. 6.

A549 cells were cultured, treated, and analyzed as described in Examples1 and 2. The highest concentration of paclitaxel used in this assay was10 nM and the concentrations of Compound I-7 were 3 μM and 6 μM. Theobserved EC₅₀ values of paclitaxel were 4.8 nM when Compound I-7 was notpresent, 2.5 nM when Compound I-7 was present at a concentration of 3μM, and 0.7 nM when Compound I-7 was present at a concentration of 6 μM.See FIG. 7.

SK-OV-3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of paclitaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 2 μM, 4 μM,8 μM, and 10 μM. The observed EC₅₀ values of paclitaxel were 9.7 nM whenCompound I-7 was not present, 9.4 nM when Compound I-7 was present at aconcentration of 2 μM, 4.8 nM when Compound I-7 was present at aconcentration of 4 μM, 4.7 nM when Compound I-7 was present at aconcentration of 8 μM, and 5.2 nM when Compound I-7 was present at aconcentration of 10 μM. See FIG. 8.

OVCAR3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of paclitaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of paclitaxel were 3.3 nM when Compound I-7was not present, 2.8 nM when Compound I-7 was present at a concentrationof 3 μM, and 1.7 nM when Compound I-7 was present at a concentration of6 μM. See FIG. 9.

Example 4. Combination of a Molecule Effective Against Quiescent CancerCells with Docetaxel

SW620 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of docetaxel used in thisassay was 100 nM and the concentrations of Compound I-5 were 2 μM and 4μM. The observed EC₅₀ values of docetaxel were 2.85 nM when Compound I-5was not present, 0.69 nM when Compound I-5 was present at aconcentration of 2 and <0.015 nM when Compound I-5 was present at aconcentration of 4 μM. See FIG. 10.

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of docetaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of docetaxel were 0.64 nM when Compound I-7was not present, 0.38 nM when Compound I-7 was present at aconcentration of 2 and 0.14 nM when Compound I-7 was present at aconcentration of 4 μM. See FIG. 11.

HCC827 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of docetaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 3 μM and 6μM. The observed EC₅₀ values of docetaxel were 1.8 nM when Compound I-7was not present, 0.6 nM when Compound I-7 was present at a concentrationof 2 and 0.03 nM when Compound I-7 was present at a concentration of 4μM. See FIG. 12.

A549 cells were cultured, treated, and analyzed as described in Examples1 and 2. The highest concentration of docetaxel used in this assay was 5nM and the concentrations of Compound I-7 were 3 μM and 6 μM. Theobserved EC₅₀ values of docetaxel were 1.4 nM when Compound I-7 was notpresent, 0.6 nM when Compound I-7 was present at a concentration of 2and 0.1 nM when Compound I-7 was present at a concentration of 4 μM. SeeFIG. 13.

SK-OV-3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of docetaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 4 μM and 8μM. The observed EC₅₀ values of docetaxel were 2.5 nM when Compound I-7was not present, 1.5 nM when Compound I-7 was present at a concentrationof 2 and 0.3 nM when Compound I-7 was present at a concentration of 4μM. See FIG. 14.

OVCAR3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of docetaxel used in thisassay was 10 nM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of docetaxel were 0.85 nM when Compound I-7was not present, 0.52 nM when Compound I-7 was present at aconcentration of 2 and <0.04 nM when Compound I-7 was present at aconcentration of 4 μM. See FIG. 15.

Example 5. Combination of a Molecule Effective Against Quiescent CancerCells with Vincristine

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vincristine used in thisassay was 10 nM and the concentrations of Compound I-5 were 2 μM and 4μM. The observed EC₅₀ values of vincristine were 1.1 nM when CompoundI-5 was not present, 0.4 nM when Compound I-5 was present at aconcentration of 2 and <0.04 nM when Compound I-5 was present at aconcentration of 4 μM. See FIG. 16.

H1975 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vincristine used in thisassay was 10 nM and the concentrations of Compound I-5 were 2 μM and 4μM. The observed EC₅₀ values of vincristine were 1.5 nM when CompoundI-5 was not present, 0.85 nM when Compound I-5 was present at aconcentration of 2 and 0.35 nM when Compound I-5 was present at aconcentration of 4 μM. See FIG. 17.

SK-OV-3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vincristine used in thisassay was 20 nM and the concentrations of Compound I-7 were 4 μM and 8μM. The observed EC₅₀ values of vincristine were 8.7 nM when CompoundI-7 was not present, 2.1 nM when Compound I-7 was present at aconcentration of 4 and 1.0 nM when Compound I-7 was present at aconcentration of 8 μM. See FIG. 18.

OVCAR3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vincristine used in thisassay was 1 nM and the concentrations of Compound I-7 were 1 μM and 3μM. The observed EC₅₀ values of vincristine were 1.2 nM when CompoundI-7 was not present, 0.8 nM when Compound I-7 was present at aconcentration of 2 and 0.1 nM when Compound I-7 was present at aconcentration of 4 μM. See FIG. 19.

Example 6. Combination of a Molecule Effective Against Quiescent CancerCells with

Vinorelbine

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vinorelbine used in thisassay was 10 nM and the concentrations of Compound I-5 were 2 μM and 4μM. The observed EC₅₀ values of vinorelbine were 1.1 nM when CompoundI-5 was not present, 0.4 nM when Compound I-5 was present at aconcentration of 2 and <0.04 nM when Compound I-5 was present at aconcentration of 4 μM. See FIG. 20.

H1975 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vinorelbine used in thisassay was 10 nM and the concentrations of Compound I-5 were 2 μM and 4μM. The observed EC₅₀ values of vinorelbine were 9.5 nM when CompoundI-5 was not present, 5.2 nM when Compound I-5 was present at aconcentration of 2 and 2.1 nM when Compound I-5 was present at aconcentration of 4 μM. See FIG. 21.

OVCAR3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vinorelbine used in thisassay was 10 nM and the concentrations of Compound I-7 were 1 μM and 3μM. The observed EC₅₀ values of vinorelbine were 2.4 nM when CompoundI-7 was not present, 2.4 nM when Compound I-7 was present at aconcentration of 1 and 0.1 nM when Compound I-7 was present at aconcentration of 3 μM. See FIG. 22.

SK-OV-3 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of vinorelbine used in thisassay was 40 nM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of vinorelbine were 15.1 nM when CompoundI-7 was not present, 10.1 nM when Compound I-7 was present at aconcentration of 2 and 4.7 nM when Compound I-7 was present at aconcentration of 4 μM. See FIG. 23.

A549 cells were cultured, treated, and analyzed as described in Examples1 and 2. The highest concentration of vinorelbine used in this assay was50 nM and the concentrations of Compound I-7 were 2 μM and 4 μM. Theobserved EC₅₀ values of vinorelbine were 27 nM when Compound I-7 was notpresent, 16 nM when Compound I-7 was present at a concentration of 2 and6 nM when Compound I-7 was present at a concentration of 4 μM. See FIG.24.

Example 7. Combination of a Molecule Effective Against Quiescent CancerCells with BI2536

H1975 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of BI2536 used in this assaywas 50 nM and the concentrations of Compound I-7 were 2 μM and 4 μM. Theobserved EC₅₀ values of BI2536 were 46.3 nM when Compound I-7 was notpresent, 17.3 nM when Compound I-7 was present at a concentration of 2and <0.04 nM when Compound I-7 was present at a concentration of 4 μM.See FIG. 25.

PANC1 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of BI2536 used in this assaywas 50 nM and the concentrations of Compound I-7 were 2 μM and 4 μM. Theobserved EC₅₀ values of BI2536 were 7.3 nM when Compound I-7 was notpresent, 4.4 nM when Compound I-7 was present at a concentration of 2and 2.5 nM when Compound I-7 was present at a concentration of 4 μM. SeeFIG. 26.

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of BI2536 used in this assaywas 50 nM and the concentrations of Compound I-7 were 2 μM and 4 μM. Theobserved EC₅₀ values of BI2536 were 6.2 nM when Compound I-7 was notpresent, 4.1 nM when Compound I-7 was present at a concentration of 2and 1.7 nM when Compound I-7 was present at a concentration of 4 μM. SeeFIG. 27.

A549 cells were cultured, treated, and analyzed as described in Examples1 and 2. The highest concentration of BI2536 used in this assay was 50nM and the concentrations of Compound I-7 were 3 μM and 6 μM. Theobserved EC₅₀ values of BI2536 were 6.2 nM when Compound I-7 was notpresent, 4.1 nM when Compound I-7 was present at a concentration of 3and 1.7 nM when Compound I-7 was present at a concentration of 6 μM. SeeFIG. 28.

Example 8. Combination of a Molecule Effective Against Quiescent CancerCells with GSK461364

H1975 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of GSK461364 used in thisassay was 10 μM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of GSK461364 were 1.9 μM when Compound I-7was not present, 0.97 μM when Compound I-7 was present at aconcentration of 2 and 0.58 μM when Compound I-7 was present at aconcentration of 4 μM. See FIG. 29.

PANC1 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of GSK461364 used in thisassay was 10 μM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of GSK461364 were 0.5 μM when Compound I-7was not present, 0.3 μM when Compound I-7 was present at a concentrationof 2 and 0.2 μM when Compound I-7 was present at a concentration of 4μM. See FIG. 30.

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The highest concentration of GSK461364 used in thisassay was 10 μM and the concentrations of Compound I-7 were 2 μM and 4μM. The observed EC₅₀ values of GSK461364 were 0.43 μM when Compound I-7was not present, 0.24 μM when Compound 1-7 was present at aconcentration of 2 and 0.12 μM when Compound I-7 was present at aconcentration of 4 μM. See FIG. 31.

A549 cells were cultured, treated, and analyzed as described in Examples1 and 2. The highest concentration of GSK461364 used in this assay was 1μM and the concentrations of Compound I-7 were 3 μM and 6 μM. Theobserved EC₅₀ values of GSK461364 were 1.2 μM when Compound I-7 was notpresent, 0.5 μM when Compound I-7 was present at a concentration of 3and 0.2 μM when Compound I-7 was present at a concentration of 6 μM. SeeFIG. 32.

Example 9. Cell Cycle Effects and Cytotoxicity of Paclitaxel andCombination of a Molecule Effective Against Quiescent Cancer Cells withPaclitaxel

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The results when different concentrations ofpaclitaxel, Compound I-7, or both paclitaxel and Compound I-7 arepresent are shown in FIG. 33.

In this experiment it was demonstrated that exposure of DMS273 cells topaclitaxel does not result in pharmacological quiescence as the fractionof cells in G₀ phase of the cell cycle was similar with or withoutpaclitaxel. It was also demonstrated that combination of Compound I-7with paclitaxel strongly affected the cell cycle distribution of DMS273cells and resulted in significant reduction of the fraction of cells inG₀. Moreover, the cytotoxicity of the combination was significantlyhigher than that of paclitaxel alone as evidenced by significantincreases in fraction of apoptotic cells observed as sub-G₀ population.

The cell cycle distributions of normally proliferating DMS273 cellsincubated in regular growth medium (FBS+) and DMS273 cells pre-incubatedin serum free media (FBS−) are shown for comparison.

SW620 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The results when different concentrations ofpaclitaxel, Compound I-7, or both paclitaxel and Compound I-7 arepresent are shown in FIG. 34.

In this experiment it was demonstrated that exposure of SW620 cells topaclitaxel does not result in pharmacological quiescence as the fractionof cells in G₀ phase of the cell cycle was similar with or withoutpaclitaxel in cells incubated in growth medium (FBS+). It was alsodemonstrated that combination of Compound I-7 with paclitaxel stronglyaffected the cell cycle distribution of SW620 cells and resulted insignificant reduction of the fraction of cells in G₀. Moreover, thecytotoxicity of the combination was significantly higher than that ofpaclitaxel alone as evidenced by significant increases in fraction ofapoptotic cells observed as sub-G₀ population.

The cell cycle distributions of normally proliferating SW620 cellsincubated in regular growth medium (FBS+) and SW620 cells pre-incubatedin serum free media (FBS−) are shown for comparison.

Example 10. Cell Cycle Effects and Cytotoxicity of Vincristine andCombination of a Molecule Effective Against Quiescent Cancer Cells withVincristine

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The results when different concentrations ofvincristine, Compound I-7, or both vincristine and Compound I-7 arepresent are shown in FIG. 35.

In this experiment it was demonstrated that exposure of DMS273 cells tovincristine does not result in pharmacological quiescence as thefraction of cells in G₀ phase of the cell cycle was similar with orwithout vincristine in cells incubated in growth medium (FBS+). It wasalso demonstrated that combination of Compound I-7 with vincristinestrongly affected the cell cycle distribution of DMS273 cells andresulted in significant reduction of the fraction of cells in G₀.Moreover, the cytotoxicity of the combination was significantly higherthan that of vincristine alone as evidenced by significant increases infraction of apoptotic cells observed as sub-G₀ population.

The cell cycle distributions of normally proliferating DMS273 cellsincubated in regular growth medium (FBS+) and DMS273 cells pre-incubatedin serum free media (FBS−) are shown for comparison.

Example 11. Cell Cycle Effects and Cytotoxicity of Vinorelbine andCombination of a Molecule Effective Against Quiescent Cancer Cells withVinorelbine

DMS273 cells were cultured, treated, and analyzed as described inExamples 1 and 2. The results when different concentrations ofvinorelbine, Compound I-7, or both vinorelbine and Compound I-7 arepresent are shown in FIG. 36.

In this experiment it was demonstrated that exposure of DMS273 cells tovinorelbine does not result in pharmacological quiescence. It was alsodemonstrated that combination of Compound I-7 with vinorelbine affectedthe cell cycle distribution of DMS273 cells and resulted in significantreduction of the fraction of cells in G₀. Moreover, the cytotoxicity ofthe combination was significantly higher than that of vinorelbine aloneas evidenced by significant increases in fraction of apoptotic cellsobserved as sub-G₀ population.

The cell cycle distributions of normally proliferating DMS273 cellsincubated in regular growth medium (FBS+) and DMS273 cells pre-incubatedin serum free media (FBS−) are shown for comparison.

Example 12. Cell Cycle Effects of AZ191 and Comparison with Compound I-7

The SW620 cells were cultured and treated as described in Example 1. Forpropidium iodide (PI) staining, manufacturer's protocol supplied withthe Guava Cell Cycle Reagent for Flow Cytometry (EMD Millipore) wasfollowed. The measurements were performed with Guava PCA-96 flowcytometer (EMD Millipore) using the green laser for excitation at 535 nmand monitoring emission at 617 nm.

The results when different concentrations of AZ191 were present areshown in FIG. 37. The data are average of two replicates.

The SW620 cells were cultured, treated, and analyzed as described inExamples 1. For propidium iodide (PI) staining, manufacturer's protocolsupplied with the Guava Cell Cycle Reagent for Flow Cytometry (EMDMillipore) was followed. The measurements were performed with GuavaPCA-96 flow cytometer (EMD Millipore) using the green laser forexcitation at 535 nm and monitoring emission at 617 nm.

The results when different concentrations of Compound I-7 were presentare shown in FIG. 38. The data are average of two replicates.

In these experiments, SW620 cells were incubated for 24 hours in FBS−media, which contained different concentrations of either AZ191 orCompound I-7. Under these conditions, exposure to AZ191 led to nodecrease in fraction of cells in quiescent state (G₀) based on noobserved change in the fraction of cells G₀+G₁ phase. Under the sameconditions, exposure to same or lower concentrations of Compound I-7 ledto a significant decrease in fraction of cells in quiescent state (G₀)based on the significant decrease in the fraction of cells G₀+G₁ phase.

AZ191 inhibits DYRK1B at 17 nM (Ashford A L, Oxley D, Kettle J, HudsonK, Guichard S, Cook S J, Lochhead P A (2014) A novel DYRK1B inhibitorAZ191 demonstrates that DYRK1B acts independently of GSK3beta tophosphorylate cyclin D1 at Thr(286), not Thr(288). Biochemical Journal457, 43-56).

In this experiment, it was demonstrated that not all DYRK1 inhibitorsare effective against quiescent cancer cells.

While this invention has been particularly shown and described withreferences to example embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

1. A method for treating a subject having a neoplasm, the methodcomprising administering to the subject, sequentially or concomitantly,(a) a DYRK1 inhibitor which inhibits DYRK1A or DYRK1B kinase activitywith an IC₅₀ of 100 nM or lower in biochemical assays, and reduces thefraction of quiescent cancer cells (in vitro or in vivo) that wouldotherwise be found in the absence of such inhibitor by at least 10%; and(b) administering to the subject an inhibitor of mitosis.
 2. The methodof claim 1, further comprising administering to the subject an effectiveamount of radiation therapy.
 3. The method of claim 1, wherein theneoplasm being treated is either a primary or a metastatic cancerselected from biliary cancer, brain cancer, breast cancer, cervicalcancer, colon cancer, gastric cancer, kidney cancer, head and neckcancer, leukemia, liver cancer, lung cancer, lymphoma, ovarian cancer,pancreatic cancer, prostate cancer, rectal cancer, sarcoma, skin cancer,testicular cancer, thyroid cancer, uterine cancer, bladder cancer,breast cancer, colorectal cancer, ovarian cancer, and prostate cancer.4. The method of claim 1, wherein the neoplasm being treated is either aprimary or metastatic colon cancer, non-small cell lung cancer, ovariancancer, prostate cancer, small cell lung cancer, or pancreatic cancer.5. The method of claim 1, wherein the inhibitor of mitosis is a taxane,a vinca alkaloid, or a PLK1 inhibitor.
 6. The method of claim 1, whereinthe inhibitor of mitosis is selected from BMS-188796, BMS-188797,cabazitaxel, DEP cabazitaxel, docetaxel, larotaxel (XP9881, RPR109881),paclitaxel, taxoprexin (DHA-paclitaxel), and tesetaxel (DJ-927).
 7. Themethod of claim 1, wherein the inhibitor of mitosis is selected fromvinblastine, vincristine, vindesine, vinflunine, and vinorelbine.
 8. Themethod of claim 1, wherein the inhibitor of mitosis is vintafolide. 9.The method of claim 1, wherein the inhibitor of mitosis is selected froma list of BI-2536, GSK461364, GW843682X, HMN-214 and HMN-176, MLN-0905,NMS-P937, rigosertib, Ro3280, SBE 13, and volasertib.
 10. The method ofclaim 1, wherein the DYRK1 inhibitor is selected from I-1, I-2, I-3,I-4, I-5, I-6, and I-7.
 11. A method for treating a subject having aneoplasm, the method comprising administering to the subject,sequentially or concomitantly, a DYRK1 inhibitor and administering tothe subject an inhibitor of mitosis, wherein the EC₅₀ value of theinhibitor of mitosis is at least 20% lower in the combination treatmentwhen compared to the same treatment with the inhibitor of mitosis alone,as determined in cell-based assays.
 12. The method of claim 11, whereinthe DYRK1 inhibitor has a Formula I

or a pharmaceutically acceptable salt or solvate thereof, wherein R₁ isa substituted or unsubstituted C₁₋₈ alkyl, a substituted orunsubstituted phenyl, or a substituted or unsubstituted benzyl; R₂ isphenyl, optionally substituted with up to four groups independentlyselected from halo, CN, NO₂, NHC(O)C₁₋₄ alkyl, C₁₋₄ alkyl, OH, OC₁₋₄alkyl, wherein two adjacent groups and their intervening carbon atomsmay form a 5- to 6-membered ring containing one or more heteroatomsselected from N, O, or S.
 13. The method of claim 11, further comprisingadministering to the subject an effective amount of radiation therapy.14. The method of claim 11, wherein the neoplasm being treated is eithera primary or metastatic cancer selected from biliary cancer, braincancer, breast cancer, cervical cancer, colon cancer, gastric cancer,kidney cancer, head and neck cancer, leukemia, liver cancer, lungcancer, lymphoma, ovarian cancer, pancreatic cancer, prostate cancer,rectal cancer, sarcoma, skin cancer, testicular cancer, thyroid cancer,uterine cancer, bladder cancer, breast cancer, colorectal cancer,ovarian cancer, and prostate cancer.
 15. The method of claim 11, whereinthe neoplasm being treated is either a primary or metastatic coloncancer, non-small cell lung cancer, ovarian cancer, prostate cancer,small cell lung cancer, or pancreatic cancer.
 16. The method of claim11, wherein the inhibitor of mitosis is a taxane, a vinca alkaloid, or aPLK1 inhibitor.
 17. The method of claim 11, wherein the inhibitor ofmitosis is selected from BMS-188796, BMS-188797, cabazitaxel, DEPcabazitaxel, docetaxel, larotaxel (XRP9881, RPR109881), paclitaxel,taxoprexin (DHA-paclitaxel), and tesetaxel (DJ-927).
 18. The method ofclaim 11, wherein the inhibitor of mitosis is selected from a list ofvinblastine, vincristine, vindesine, vinflunine, and vinorelbine. 19.The method of claim 11, wherein the inhibitor of mitosis is vintafolide.20. The method of claim 11, wherein the inhibitor of mitosis is selectedfrom BI-2536, GSK461364, GW843682X, HMN-214 and HMN-176, MLN-0905,NMS-P937, rigosertib, Ro3280, SBE 13, and volasertib.
 21. The method ofclaim 11, wherein the DYRK1 inhibitor is selected from I-1, I-2, I-3,I-4, I-5, I-6, and I-7.
 22. A method for treating a subject having aneoplasm, the method comprising administering to the subject,sequentially or concomitantly, a DYRK1 inhibitor and administering tothe subject an inhibitor of mitosis, wherein the combination treatmentincreases fraction of apoptotic cells in a treated population ascompared to either agent alone by at least by 2-fold, as determined byfraction of sub-G₀ cells by a FACS assay.
 23. The method of claim 22,wherein the DYRK1 inhibitor has a Formula I

or a pharmaceutically acceptable salt or solvate thereof, wherein, R1 isa substituted or unsubstituted C1-8 alkyl, a substituted orunsubstituted phenyl, or a substituted or unsubstituted benzyl; R2 isphenyl, optionally substituted with up to four groups independentlyselected from halo, CN, NO2, NHC(O)C1-4 alkyl, C1-4 alkyl, OH, OC1-4alkyl, wherein two adjacent groups and their intervening carbon atomsmay form a 5- to 6-membered ring containing one or more heteroatomsselected from N, O, or S.
 24. The method of claim 22, further comprisingadministering to the subject an effective amount of radiation therapy.25. The method of claim 22, wherein the neoplasm being treated is aeither a primary or metastatic cancer selected from biliary cancer,brain cancer, breast cancer, cervical cancer, colon cancer, gastriccancer, kidney cancer, head and neck cancer, leukemia, liver cancer,lung cancer, lymphoma, ovarian cancer, pancreatic cancer, prostatecancer, rectal cancer, sarcoma, skin cancer, testicular cancer, thyroidcancer, uterine cancer, bladder cancer, breast cancer, colorectalcancer, lung cancer, ovarian cancer, and prostate cancer.
 26. The methodof claim 22, wherein the neoplasm being treated is either a primary ormetastatic colon cancer, non-small cell lung cancer, ovarian cancer,prostate cancer, small cell lung cancer, pancreatic cancer.
 27. Themethod of claim 22, wherein the inhibitor of mitosis is a taxane, avinca alkaloid, or a PLK1 inhibitor.
 28. The method of claim 22, whereinthe inhibitor of mitosis is selected from BMS-188796, BMS-188797,cabazitaxel, DEP cabazitaxel, docetaxel, larotaxel (XRP9881, RPR109881),paclitaxel, taxoprexin (DHA-paclitaxel), and tesetaxel (DJ-927).
 29. Themethod of claim 22, wherein the inhibitor of mitosis is selected from alist of vinblastine, vincristine, vindesine, vinflunine, andvinorelbine.
 30. The method of claim 22, wherein the inhibitor ofmitosis is vintafolide.
 31. The method of claim 22, wherein theinhibitor of mitosis is selected from BI-2536, GSK461364, GW843682X,HMN-214 and HMN-176, MLN-0905, NMS-P937, rigosertib, Ro3280, SBE 13, andvolasertib.
 32. The method of claim 22, wherein the DYRK1 inhibitor isselected from I-1, I-2, I-3, I-4, I-5, I-6, and I-7.